An adult patient presents to the ED with a gunshot wound to the chest. VS: BP 90/50; HR 120; RR 24; SpO2 86%. When anticipating treatment for this patient, the nurse recognizes the primary goal of treatment is to:
Increase afterload
Decrease afterload
Increase preload
Decrease preload
The Correct Answer is C
Rationale:
A. Increasing afterload (the resistance the heart must pump against) is not the priority in this patient. In hypovolemic or cardiogenic shock due to trauma, increasing afterload could further strain cardiac output and worsen tissue perfusion.
B. Decreasing afterload is sometimes used in cases of heart failure to reduce cardiac workload, but in acute traumatic shock with hypotension, afterload reduction could further lower perfusion pressure and is not the primary goal.
C. The primary goal in a patient with hypotension and tachycardia following chest trauma is to increase preload (the volume of blood returning to the heart). Gunshot wounds to the chest can cause hemorrhagic shock, leading to decreased circulating blood volume. Restoring preload through rapid fluid resuscitation or blood products helps increase stroke volume and cardiac output, improving blood pressure, oxygen delivery, and perfusion of vital organs.
D. Decreasing preload would worsen hypotension and compromise organ perfusion. Reducing venous return in a patient already hypovolemic is contraindicated.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. 3.3 mL would deliver approximately 742 mg, which is far above the prescribed dose.
B. 1.1 mL provides approximately 250 mg, matching the provider’s order.
First, identify the ordered dose and the available concentration.
Ordered dose = 250 mg
Available concentration = 225 mg per 1 mL
Use the medication calculation formula:
Amount to administer (mL) = Ordered dose ÷ Concentration
250 mg ÷ 225 mg/mL = 1.11 mL, which rounds to 1.1 mL
C. 2.5 mL refers to the reconstitution volume, not the amount to administer.
D. 1 mL would deliver only 225 mg, which is less than the prescribed dos
Correct Answer is A
Explanation
Rationale:
A. Emergent is correct because the patient exhibits life- and limb-threatening conditions. Active hemorrhage, pale and cool distal extremity, absent capillary refill, and loss of motor and sensory function indicate severe arterial bleeding and possible neurovascular compromise. Emergent triage is necessary to prevent exsanguination and permanent limb ischemia.
B. Urgent is incorrect because although urgent conditions require prompt attention, this patient’s vascular compromise and ongoing hemorrhage constitute an immediate threat to life and limb, which is higher priority than standard urgent care.
C. Non-urgent is incorrect because non-urgent patients are stable and can safely wait for assessment; this patient is hemodynamically unstable and at risk for permanent disability.
D. Fast track is incorrect because fast track is for minor, uncomplicated injuries that can be treated quickly; this patient’s injury is severe with active bleeding and neurovascular compromise.
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